Factors Affecting Under-Five Mortality in Ethiopia: a Multi-Level Negative Binomial Model

Introduction: Under-five mortality is a key indicator of countries’ developmental status. Even though remarkable declines in under-five mortality rates, nearly 5.6 million children still die annually worldwide before their fifth birthday. The 2016 Ethiopian Demographic and Health Survey (EDHS) report revealed that 67 children per 1,000 live births died before the fifth birthday. This study was aimed at determining factors affecting under-five mortality in Ethiopia using EDHS, 2016.Methods: The data was retrieved from the EDHS 2016. A total weighted number of 11,023 under-five children were included in this study. Descriptive statistics were done and reported using tables, graphs, and texts. The multilevel negative binomial regression model was fitted to identify significant factors of under-five mortality. Adjusted Incidence rate (AIRR) with a 95% confidence interval (CI) and p-value <0.05 in the multivariable model were reported. The goodness of fit was checked using the deviance test.Results: Mother attained higher education (AIRR=0.25, 95% CI: 0.10-0.66); female-headed household (AIRR=1.32, 95%CI:1.05-1.66); age of household head (AIRR=1.07, 95%CI: 1.03,1.11); preceding birth interval ≥48 months (AIRR=0.51, 95%CI: 0.42-0.61); child’s had history of diarrhea (AIRR=1.23, 95% CI:1.08-1.41); multiple birth type (AIRR=1.80, 95% CI:1.34-2.42); mothers delivered in health facility (IRR=0.86, 95% CI:0.73,0.94), residents of Addis Ababa (AIRR=0.52, 95%CI: 0.28-0.98), and Amhara region (AIRR=1.43, 95%CI: 1.09, 1.88) were statistically significant factors to under-five mortality in Ethiopia.Conclusion: In this study, under-five mortality remains a public health problem in Ethiopia. Mothers education level, women delivered at health institution, preceding birth interval 24-35 and ≥48, and residents of Addis Ababa have reduced the incidence of under-five mortality. On the other hand, being a female household head, age of mother at first giving birth, being employment, having multiple births and having childhood diarrhea was associated with a higher incidence of under-five mortality. This finding suggests that enhancing opportunities to female education, addressing regional disparities, and encouraging mothers to deliver at health institutions will help to combat the burden of under-five mortality. Keywords: Under-five mortality, negative binomial, multilevel analysis, Ethiopia